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Forteo (teriparatide) followed by HRT: My Experience
I wanted to start a thread sharing my experience with Forteo → HRT, since this treatment sequence is less discussed but may be very helpful for other women navigating osteoporosis.
I was diagnosed with osteoporosis at age 59. My lowest T-score was –3.4 at the lumbar spine, with hip and femoral neck in the osteopenia/borderline osteoporosis range. My endocrinologist ruled out secondary causes. Without a family history, postmenopausal estrogen deficiency seemed the most likely contributor, though low BMI, protein intake, and activity level/type may have played a role.
Shortly after diagnosis, I improved my diet and added weight-bearing exercise. I started Forteo (teriparatide) within a few months and continued for 22 months. P1NP was 137 µg/L at the end of Forteo.
At age 61 (11 years postmenopausal), I transitioned to HRT: transdermal estradiol 0.025 mg/day patches plus oral micronized progesterone 100 mg/day. It’s now been 15 months on HRT. CTX stayed 110–130 pg/mL after 6mo starting HRT.
Since the start of Forteo to 15 months on HRT, my results have improved as follows:
• Lumbar spine T-score: –3.4 to –1.9
• Total hip T-score: –2.2 to –1.7
• Femoral neck T-score: –2.5 to –1.8
• TBS: 1.264 to 1.34
All DXA scans were performed on the same machine by the same technician. Detailed DXA results, including percent changes from previous scans and baseline, T-scores, and TBS values, are presented in the attached spreadsheet if anyone is interested.
Between my last two DXA scans, I also used three leftover Forteo pens with off-label dosing.
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Note: I use the term “HRT” because it’s widely recognized. In medical literature, “MHT” (menopausal hormone therapy) is the standard term. In my case, I used regulated, body-identical estradiol and micronized progesterone, sometimes referred to as bHRT.
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Thanks for reading! I would love to hear your thoughts, experiences, and insights. Also please feel free to ask any questions.
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Hello,I’m 70 now and have just had my Dexa scan done resulting in -2.5,I’m reluctant to take the meds for oesteoporosis which the diagnosis showed that I have in the spine and oesteopenia in left hip and neck
I have been off HRT for six years now ,was strongly advised by the doctor to stop taking it for risk of stroke,I’m so sorry that I had taken that advice as everything declined after that.Im going to see an endocrinologist to see if I could go back on hormone therapy for my bone health even though I’m 70 .
I’ve just had a calcium score done and it is 0 which shows no plaque in my arteries,so here’s hoping .
Menopause.org
@tesslu2
I might do some research on what we know now about starting hrt later in life. I started at 77 . Menopause at 38. It is very individual but I know I will never stop taking hormones
Take a look at some of the YouTube videos by Dr. Susan Hardwick-Smith and Dr. Mary Claire Havers book The Pause Life.
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1 Reaction@gravity3 I had a hysterectomy at 33 I wonder if I could take this. I am looking for a new rheumatologist because mine keeps pushing recast and Prolia and I have health problems to where I cannot take these. I have kidney problems, auto immune no thyroid . I am 64 years old she told me I am too old for hormones and told me to find another doctor so I have been
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2 Reactions@mayblin I just found out I have calcifications in my vascular abdominal aorta. I wonder if this would not work then. My doctor wants me to look for another rheumatologist because I don’t want to take things that she keeps pushing that could hurt me
@vmcgrantham
I am not a doctor and don't know your medical history but I encourage you to do some reading and research of your own. Not all doctors have the latest information but you can prepare ahead for a second opinion meeting with a rheumatologist, endocrinologist.
The most current thinking on osteoporosis medication sequencing seems to be start with an anabolic like forteo or tymlos. Make sure that you find out what training and experience your new doc has with osteoporosis, menopause and hormone replacement and they are up to date on new finding and research. Are they or their medical system still operating under the influence of the old women's health initiative study.
Dr. Mary Claire Havers book The Pause Life
YouTube videos by Dr. Susan Hardwick-Smith
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3 Reactions@vmcgrantham
To my knowledge, abdominal aortic calcification (AAC) is a marker of systemic atherosclerotic disease and vascular aging. If you're considering HRT, it may be worth discussing a thorough cardiovascular evaluation with your physicians. Your endo or rheumatologist can help determine whether HRT alone (if you don't want to take other OP meds) is an appropriate and sufficient approach for managing your bone health.
In my case, I underwent comprehensive evaluations by two cardiologists because of my positive CAC score. One of them recommended more stringent LDL-c and HbA1c targets based on my overall cvd risk profile. My endo was supportive of my decision to pursue HRT, considering my response to Forteo treatment and my low FRAX score.
None of these decisions is straightforward. Hope you're able to sort through the options with your team of physicians and find the approach that best fits your situation.
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2 ReactionsDid you go on HRT at the same time as Forteo treatment? I am on Forteo currently and have 8 months to go. I am 63 and had a hysterectomy at 61. I just had my bloodwork done for the BHRT specialist. All looked good I do have a slight Calc store as well. My cardiologist said it would be OK for me to start therapy. My endocrinologist is conflicted. She said the compounding pharmacies aren't regulated. Thoughts?
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1 Reaction@smodesitt
Does your endocrinologist do pellets? That may be a path for you but I wonder if you might have to try a functional medicine practice for that. If you are also adding testosterone you can have a pellet inserted with both estradiol and testosterone. They last about 12 weeks but Medicare does not cover them.
At 78 risk is not not such an issue when I am much nearer death.
Thank you for your quick response. I'm not yet medicare age, but I still don't think it's covered by insurance. I'm working with a functional medicine doctor (wife of my ob/gyn). Currently I take daily Forteo injections and had my DEXA scan yesterday. Hope for improvement. I started April 2025, 2 months after my hysterectomy.
I'm not much on all sort of medication, but I'd like to feel better. I have severe spinal stenosis, and just doing daily exercises. The steroid shot worked but it only lasted 2 months. I was an avid runner and literally ruined my body. I also had an eating disorder in my teens and 20s, a big factor with my osteoporosis.
My endocrinologist isn't too keen on BHRT, but my cardiologist (I have a genetic lipoprotein little (a) disorder) said it's OK.
I should get my test results back real soon.
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